Update in the treatment of type 2 diabetes mellitus. The alpha-glucosidaseinhibitors.

The development of antidiabetic drugs with complementary mechanisms of acti on appears more and more necessary in order to achieve durable glycaemic co ntrol in type 2 diabetes. By inhibiting in a reversible way the hydrolysis of disaccharides and the ultimate steps of the digestion of dietary polysac charides, alpha-glucosidase inhibitors reduce postprandial blood glucose mi se in diabetics. This therapeutic class, limited in Europe until recently t o acarbose, has been enlarged with the marketing of miglitol, whose pharmac okinetic properties might lead to better long term tolerance. The improveme nt of glycaemic control obtained with alpha-glucosidase inhibitors is now b etter evaluated and appears similar whatever the combinations with other an tidiabetic drugs, including insulin. The role of alpha-glucosidase inhibito rs in the overall therapeutic strategy of type 2 diabetes and their benefit on the evolution of long term complications remains to be clarified (C) 19 99 Elsevier, Paris.